Outcomes of endothelial keratoplasty with descemetorhexis (DSEK)

PURPOSE: Analysis of morphologic and functional outcomes of endothelial keratoplasty with descemetorhexis technique for recipient Descemet's membrane removal (DSEK). MATERIAL AND METHODS: We analyzed patients treated for chronic endothelial dysfunction with DSEK technique. For the study 12 patients (12 eyes) with follow up at least 9 months, were qualified. Study group consisted of 9 women and 3 men, in age from 53 to 83 years, mean 72.9 +/- 7.82 years. All surgery were performed by one surgeon (EW). Anterior chamber was opened through 5 mm wide and 3 mm long sclero-corneal tunnel. Before descemetorhexis incision points on the endothelial side of cornea were done with radio-frequency diathermy. Descemet's membrane stripping was done with the forceps. Endothelial grafts were fixed with anterior chamber by air tamponade. We analyzed postoperative visual acuity (on Snellen's charts), corneal transparency, endothelial cell density, total central corneal thickness and endothelial button (with OCT Visante), and complications of the surgery. RESULTS: 9 months postoperatively VA ranged from 0.1 to 0.5 (mean 0.28 +/- 0.15), BCVA ranged 0.1-0.9 (mean 0.43 +/- 0.30). Endothelial cell density ranged from 982 to 2781 cells per square millimeter (mean 1848.5 +/- 550.7). Total central corneal thickness ranged from 642 to 998 microm (mean 791.6 +/- 38.0 microm) before surgery and from 536 to 789 microm (mean 645 +/- 61.3 microm) 12 months postoperatively. Total central thickness of the endothelial graft 12 months postoperatively ranged from 42 to 163 microm (mean 89.1 +/- 38.2 microm). One penetrating keratoplasty was made for graft failure. Due to endothelial graft detachment or dislocation in anterior chamber, air tamponade was made in 5 cases with satisfactory final result. Only one case of the rejection was observed. CONCLUSIONS: Endothelial keratoplasty (DSEK) is safe and effective procedure in treatment of the endothelial cell dysfunction. Surgery supported by descemetorhrexis is easy and quick and results in smooth endothelial graft bed. The DSEK technique decreases surgery time and number of corneal graft dislocations.     

Programme preventing vision loss due to diabetes

Diabetic visual complications prevention relies, on the one hand, on an intensive metabolic control of diabetes and elimination of coexisting risk factors for development of diabetic retinopathy and, on the other hand on carrying out a programme for early detection and treatment of diabetic retinopathy. Proper treatment of diabetes, expressed by good glycaemia control, proper arterial pressure parameters and lipid concentration in blood reduce the risk of heavy complications and extends life span and improves its quality. An ideal model of screening studies towards diabetic retinopathy is based on an annual examination of vision acuity and eye fundus in all diabetic patients, by an experienced ophthalmologist using precise methods for imaging eye fundus. Examination of the eye fundus completed with fluorescein angiography make a golden standard in retinopathy diagnosis and classification. The incidence of vision loss due to diabetes is significantly lower in the countries which introduced programs preventing retinopathy than in those which do not have them.     

Serum level of sELAM-1 in psoriatic patients correlates with disease activity

BACKGROUND: Endothelial leucocyte adhesion molecule-1 (ELAM-1) acts as an adhesion ligand for neutrophils and monocytes and the expression of this molecule on the vascular endothelium may reflect its ability to recruit neutrophils from circulation. The next step is the transendothelial migration of neutrophils into lesional psoriatic skin. ELAM-1 may also exist in a soluble form. METHODS: We determined the serum levels of ELAM-1 by ELISA in 41 patients with psoriasis and 20 controls. RESULTS: Patients with acute psoriasis displayed higher levels of ELAM-1 (85.45 +/- 47.72 ng/ml) than controls (36.02 +/- 15.60 ng/ml) and patients with chronic disease (61.24 +/- 27.91 ng/ml). In 25 patients we measured the serum level of ELAM-1 twice: at the beginning and after treatment of the disease and we did not find any significant changes. We also found a correlation between serum ELAM-1 and PASI score. CONCLUSIONS: These data suggest that there is a high serum level of E-selectin in psoriatic subjects even after clearing of the disease. Serum E-selectin may reflect the general activation of endothelial cells in the disease and may be a new sensitive marker of disease activity.     

Suppression of serum lipid transfer proteins involved in high-density lipoprotein cholesterol metabolism by intensive insulin therapy in the first year of type 1 diabetes mellitus: Prospective InLipoDiab1 study

Background and aimsCholesteryl ester transfer protein (CETP) and phospholipid transfer protein (PLTP) are crucial proteins in reverse cholesterol transport. There are insufficient data on regulating these proteins by insulin therapy in type 1 diabetes mellitus (T1DM). We aimed to assess prospectively the impact of insulin therapy initiation on transfer proteins serum levels in adults with newly diagnosed T1DM.Methods and results57 adults with newly diagnosed T1DM were enrolled in the InLipoDiab1 Study. All participants were treated with subcutaneous insulin in the model of intensive insulin therapy since the diagnosis of diabetes. Serum PLTP and CETP concentrations were measured at diagnosis, after three weeks, six months, and after one year of insulin treatment, using the immunoenzymatic method ELISA.A significant decrease in PLTP and CETP concentrations were demonstrated during twelve months of insulin therapy in newly diagnosed T1DM. The dynamics of changes in the level of these proteins varied depending on the occurrence of remission after a year of the disease. In the group without remission, a significant decrease in PLTP and CETP levels appeared after six months of follow-up. The remission group was characterized by a decrease in proteins concentration only after one year of treatment. In the non-remission group, significant negative correlations were found between the daily dose of insulin and levels of PLTP and CETP.ConclusionExogenous insulin is an inhibitor of lipid transfer proteins involved in high-density lipoprotein cholesterol metabolism in the first year of treatment.     

“Cerebral small vessel disease and other influential factors of cognitive impairment in the middle-aged: a long-term observational cohort PURE-MIND study in Poland”

GeroScience - A complex picture of factors influencing cognition is necessary to be drawn for a better understanding of the role of potentially modifiable factors in dementia. The aim was to assess...     

Renal impairment in patients with chronic hepatitis C treated with first generation protease inhibitors

Background: The incidence, course and risk factors associated with renal impairment (RI) in patients treated with triple therapy (TT) with pegylated interferon, ribavirin and telaprevir/boceprevir (PR/TVR/BOC) vs. dual therapy (DT) with PR were analyzed in this study. The association between RI and the decline of hemoglobin (Hb) was also examined.

Methods: Retrospective analysis included 110 patients with genotype 1b chronic HCV infection, aged 18 – 80 years, who underwent TT (48TVR/14BOC) or DT (48 patients). The estimated glomerular filtration rate (eGFR), serum creatinine concentration (SCr) and Hb were measured at baseline, at weeks 4, 12, 24, 48 of treatment, and post-treatment week 24.

Results: RI occurred in 9/62 (14.5%) patients who underwent TT, eight of whom were treated with TVR, one with BOC, and none treated with DT. The risk factors associated with RI were the following: TT (p = 0.0078), usage of nephrotoxic drugs (p = 0.0288), and older age (p < 0.0001). RI was reversible. A drop of Hb was associated with RI, older age and TT.

Conclusions: RI is not a rare but a reversible complication of TT. It is necessary to monitor SCr and eGFR, especially in patients with a potential risk factor of RI occurrence. The Hb drop is more severe in patients with RI than in those without it.     

Association Between Self-reported Physical Activity and Skin Autofluorescence,a Marker of Tissue Accumulation of Advanced Glycation End Products in Adults With Type 1 Diabetes: A Cross-sectional Study

Purpose

The accumulation of advanced glycation end products (AGEs) in local tissue is an important cause of low-grade inflammation and oxidative stress and is linked to late diabetic complications. Physical activity has various beneficial cardiometabolic effects in type 1 diabetes (T1D) and is associated with lower frequency of chronic complications of diabetes, although the specific mechanisms still remain unclear. The present study determines the association between self-reported physical activity and skin autofluorescence (AF), a marker of tissue accumulation of AGEs in adults with T1D.

Mask-Guided Convolutional Neural Network for Breast Tumor Prognostic Outcome Prediction on 3D DCE-MR Images

Journal of Digital Imaging - In this proof-of-concept work, we have developed a 3D-CNN architecture that is guided by the tumor mask for classifying several patient-outcomes in breast cancer from...